Healthcare Provider Details

I. General information

NPI: 1114331196
Provider Name (Legal Business Name): OMAR ALI USMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 PINNACLE DR STE 600
TYSONS VA
22102-4007
US

IV. Provider business mailing address

5342 WOODBURY WOODS PL
FAIRFAX VA
22032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-3868
  • Fax: 571-601-2803
Mailing address:
  • Phone: 248-767-9656
  • Fax: 571-601-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101277935
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number0101277935
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101277935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: